Emergence of Escherichia coli Sequence Type 131 (ST131) and ST3948 with KPC-2, KPC-3 and KPC-8 carbapenemases from a Long-Term Care and Rehabilitation Facility (LTCRF) in Northern Italy

  • Aurora Piazza
  • Mariasofia Caltagirone
  • Ibrahim Bitar
  • Elisabetta Nucleo
  • Melissa Spalla
  • Elena Fogato
  • Roberto D’Angelo
  • Laura Pagani
  • Roberta MigliavaccaEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 901)


Aim of the study was to characterize KPC-producing Escherichia coli (KPC-Ec) clinical isolates among a Northern Italy Long-Term Care and Rehabilitation Facility (LTCRF) residents. Thirteen consecutive non repeated MDR E. coli isolates showing ertapenem Minimum Inhibitory Concentrations (MICs) >0.5 mg/L, collected during the period March 2011 – May 2013 from ASP “Redaelli” inpatients, were investigated. The bla KPC/CTX-M/SHV/TEM/OXA genes were identified by PCR and sequencing. KPC-Ec isolates underwent phylotyping, Pulsed-Field Gel Electrophoresis (PFGE), multilocus sequence typing (MLST) and repetitive sequence-based PCR (rep-PCR) profiling. Incompatibility groups analysis and conjugation were also performed. Eleven out of 13 isolates, resulted bla KPC-type positive, were consistently resistant to third generation cephalosporins, fluoroquinolones and trimethoprim-sulphametoxazole (84.6 %), retaining susceptibility to colistin (EUCAST guidelines). At least n = 4/11 of KPC-Ec patients received ≥48 h of meropenem therapy. Sequencing identified 9 bla KPC-2, 1 bla KPC-3 and 1 bla KPC-8 determinants. KPC-Ec plasmids belonged to IncF group (FIIk replicon); conjugation confirmed bla KPC/TEM-1/OXA-9 genes transferability for 10 KPC-Ec. Although three pulsotypes (A, B, C) were identified, all KPC-Ec belonged to phylogenetic group B2. Clone B (B-B5) caused an outbreak of infection involving nine inpatients at five wards. Rep-PCR showed relatedness for seven representative KPC-Ec isolates. Here we report a LTCRF outbreak caused by a ST131-B2 E. coli associated with bla KPC-2 and bla KPC-8 genes, and the emergence of the new ST3948. Elderly people with co-morbidities are at risk for ST131 colonization. KPC-Ec clones local monitoring appears essential both to avoid their spreading among healthcare settings, and to improve therapeutic choices for LTCRF residents.


Long-Term Care and Rehabilitation Facility KPC-positive E. coli Sequence Type 131 (ST131) ST3948 


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Aurora Piazza
    • 1
  • Mariasofia Caltagirone
    • 1
  • Ibrahim Bitar
    • 1
  • Elisabetta Nucleo
    • 1
  • Melissa Spalla
    • 1
  • Elena Fogato
    • 2
  • Roberto D’Angelo
    • 2
  • Laura Pagani
    • 1
  • Roberta Migliavacca
    • 1
    Email author
  1. 1.Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
  2. 2.ASP “Golgi-Redaelli”MilanItaly

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